Provider Demographics
NPI:1376163022
Name:PITTMAN, CHERISSE LYNELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHERISSE
Middle Name:LYNELLE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 JAMESVILLE AVE APT M1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3243
Mailing Address - Country:US
Mailing Address - Phone:256-487-5058
Mailing Address - Fax:
Practice Address - Street 1:1654 W ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3326
Practice Address - Country:US
Practice Address - Phone:315-424-1845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103374104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker